Liver Transplant Organ Offer Tool

About

Each time an organ comes along, the physician and potential recipient must decide whether to accept that offer or wait in hopes that a better one will come along. This decision is a high-risk one, as the wrong choice could mean death for the patient. It is also a complex one. Physicians must incorporate multiple donor factors, recipient factors, and donor-recipient interactions, as well as the local magnitude of organ shortage and various technical and logistical concerns. In a series of studies, we have shown that decisions about organ quality vary widely by transplant center, are inconsistent with the available evidence, and are susceptible to cognitive biases and external forces such as policy changes and competition between centers. Thus, this process of decision-making could stand to be improved. We hypothesize that the availability of a point-of-care decision aid could improve the consistency and accuracy of organ acceptance decision.

Aims

Aim 1: Develop and validate a patient- and donor-specific statistical model predicting the survival benefit of organ offer acceptance. Rather than comparing the survival benefit of transplantation versus no transplantation, this analysis compares transplantation with a given organ versus waiting for another organ to come along. Additionally, it is adjusted for geographic variability in organ shortage.

Aim 2: Create and pilot test a point-of-care physician decision aid for organ offers. This decision aid is designed for use on a computer or tablet. It provides information from the statistical model in SA1, as well as literature-derived estimates of waitlist mortality, graft failure risk, and disease transmission risk. Pilot testing is done to determine initial usability; future studies test the impact on clinical decision making.

Participants

Pilot testing is performed among transplant surgeons, for use in evaluating twenty organ offers.